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What Kind of Health Insurance Do I Have?

The United States healthcare system consists of both public and private insurance companies.  Each insurance company has its own coverage policiescoverage criteria and payment rates.

Public Health Insurance

Medicare and Medicaid are both public health insurance programs in the United States.  The Centers for Medicare & Medicaid Services (CMS) is the federal agency that oversees Medicare and Medicaid.

Medicare

Who does it cover?

Medicare is public health insurance for Americans age 65 and older and younger people with disabilities.

How is it funded?

Medicare is funded by the federal government.

Who runs it?

Medicare is overseen by the CMS and the Department of Health and Human Services.

Web site

For more information about Medicare,  visit the CMS Web site:  www.cms.hhs.gov 

 

Medicaid

Who does it cover? Medicaid is public health insurance for individuals and families that meet low income requirements or with certain disabilities.

How is it funded?

Medicaid is funded by both federal and state governments.

Who runs it?

The federal government sets guidelines for eligibility, and each state sets its own specific rules for who qualifies.

Web site

For more information about Medicaid, visit the following website:  http://www.medicaid.gov/ 

 

Private Health Insurance

  • Private health plans are available through:

    • Employers (Where you work.)
    • Individuals (You can purchase a plan on your own.)

  • Private health plans are run by commercial insurance companies such as Aetna, Blue Cross Blue Shield, United Healthcare, and many others. There are two main types of private health insurance plans:

    • Fully-funded plans: You or your employer purchase insurance from an insurance company and the insurance company pays the doctor and hospital for health care services.  The patient may have to pay a co-payment or deductible.
    • Self-funded plans :  The employer hires an insurance company to administer the plan, the employer (usually a large employer) pays the doctor and hospital for health care services.  The patient may have to pay a co-payment or deductible.­­­­­­­­­­­­­­­­­­­­­ 

Contact your benefits administrator in your human resources department to ask if you have a fully-funded or self- funded health plan.

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